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PA Who Sounded COVID Alarm Had Long Recovery

This is an update to a story published on March 10, 2020. You can read the original piece here.

James Cai, the physician assistant who was New Jersey’s first COVID-19 patient, no longer needs supplemental oxygen and has been back to work for several months, seeing a steady drumbeat of coronavirus patients.

Back in March, Cai made headlines for warning the country that even young, relatively healthy 32-year-olds like himself were vulnerable to the virus, which was still largely a mystery in the U.S. at the time. He was worried that he wasn’t getting the right treatment at the hospital, so he took his case to Twitter.

“In the beginning, they just treat me like normal flu. They say I’m young, I’m not going to die, but they don’t know the truth about corona[virus],” Cai said during an interview posted to Twitter at the time. That interview was with Bill Pulte, a self-described Twitter philanthropist and grandson of home-construction magnate William Pulte, and it propelled him into the national spotlight — including a profile in the New York Times in April.

Cai was admitted to the hospital on March 3. He received high-flow oxygen, chloroquine, and lopinavir/ritonavir (Kaletra), and was one of the first patients to receive remdesivir under compassionate use. He worked his connections to reach out to Chinese physicians who’d treated the disease, and a Chinese-American doctor translated Chinese protocols into English for Cai’s New Jersey doctors.

He was discharged on March 21, needing supplemental oxygen — especially at night.

Cai didn’t respond to MedPage Today‘s requests for an interview, but his Twitter feed has provided significant insights into his recovery.

Within a month of his discharge, on April 20, he went back to work as a physician assistant, but only virtually. Two months after that, as coronavirus cases began to ease in New Jersey, he went back to practicing in the clinic.

But even in mid-summer, Cai was still seeing impairments in his oxygen saturation and activity levels.

“My O2 is 97% when I am awake but it does drop to 90% when I lay down for few hours or fall into sleep,” he tweeted on July 18. “I still need O2 to sleep & do get tired very easily. I used to work 60-70 hours a week by working in the clinic, nursing home, outpatient surgery, and play[ing] with my daughter at home. Now I only work 30 hrs in the clinic. … Plus I couldn’t run and exercise like before,” he said in another tweet that day.

Through that time, he was taking dual anticoagulant therapy with rivaroxaban (Xarelto) 2.5 mg and 81 mg aspirin.

In late summer, things started to look up. On August 21, he confirmed that he could sleep through the night without oxygen, and tweeted the results of his latest chest CT: “I only have few fibrotic streaks in the left lower lung. So there is a permanent damage but it is not end of the world.”

Moving into the fall, Cai tweeted frequently about healthy eating, sharing his successes along the way to achieving his target weight and body mass: “I truly understand why the best investment is your own health after this horrible scary experience!” one tweet read.

He shared stories of his patients who were diagnosed with COVID-19, particularly the unusual cases like a teenage patient who tested positive but only had rashes and pain.

As of December, he said he was still testing positive for coronavirus antibodies.

On Thanksgiving, Cai thanked the healthcare workers, advocates, and friends who he credited with saving his life: “This has been a crazy year for everybody around the world,” he tweeted. “I really hope everything can be normalized next year due to promising vaccine!”

  • Kristina Fiore leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to [email protected] Follow

Source: MedicalNewsToday.com